Application for ACCA membership or for an ACCA affiliate

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					   2009
                                                                                                                                      MB

Application for ACCA membership or for an ACCA
affiliate certificate

Please read the whole of this form carefully before completing it. Please complete the form in black ink, using crosses or BLOCK CAPITALS
throughout.

Registration number:

Important:

INTRODUCTION OF NEW PRACTICAL EXPERIENCE REQUIREMENT (PER) AND WITHDRAWAL OF THE STUDENT TRAINING
RECORD (STR)

A key component to becoming an ACCA member is gaining relevant practical experience. As part of the ACCA Qualification
launched in 2007, ACCA introduced a number of new features to its practical experience requirements. Full details can be found at
www.accaglobal.com/students/training_careers

If you are confident that you have achieved the 16 elements of competence outlined in the STR (and detailed on pages 6–8 of this form) and
completed three years’ relevant experience then you should apply for membership using this form.

If you have transferred to the new PER and have achieved the 13 performance objectives outlined in the Trainee Development Matrix (TDM)
(detailed on page 9 of this form) and completed three years’ relevant experience then you should apply for membership using this form.

If you are not ready to apply for membership then you should apply for affiliate status using this form. You will be sent an affiliate certificate
confirming your completion of the examinations only on receipt by ACCA of this form.

Please tick one of the following boxes:

   I wish to apply for membership of ACCA on the basis that, in addition to completing the ACCA Qualification exams, I have completed my
   experience under the Student Training Record (STR) and achieved three years’ relevant experience. I have completed pages 2 – 8 and
   10 – 11.

   I wish to apply for membership of ACCA on the basis that, in addition to completing the ACCA Qualification exams, I have completed my
   experience under the new practical experience requirement (PER) and have achieved three years’ relevant experience. I have completed
   pages 2 – 5 and 9 – 11.*

   * Completed the Professional Ethics module (if you registered for the ACCA Qualification from 1 January 2007). If you registered before
   1 January 2007, you will have transferred over to the ACCA Qualification and will not be required to complete the Professional Ethics
   module. However, ACCA strongly recommends that you do.

   Upon admission to membership you will automatically receive a copy of the ACCA Rulebook in CD-ROM format.
   If you would prefer to receive this in book format, tick here (3)

   I wish to apply for ACCA affiliate status. I have completed pages 2 – 5 and page 11.
   I expect to have completed my PER and obtained three years’ relevant practical experience by (dd mm yy):




Please return this form to Customer Services (MB) ACCA 2 Central Quay 89 Hydepark Street Glasgow G3 8BW United Kingdom
      PERSONAL DETAILS

THE NEXT FOUR PAGES MUST BE COMPLETED By ALL APPLICANTS

Surname

Title (3)        Mr       Mrs        Miss       Ms       Dr       Other (please specify)

Forenames

Honours/university degrees

                                                                                                 Date of birth


Your full name (forenames followed by surname) will be printed on your affiliate or membership certificate. If you wish to have the certificate
printed showing your name in a different order, please detail here your name as you would like it printed.



Residential address

Post town/city                                                                    County/state

Country                                                                           Post/code


Business address
Job title

Company name

Company address

Post town/city                                                                    County/state

Country                                                                           Postcode

Tel             Area/STD code                                     Number

Fax             Area/STD code                                     Number


Mailing details
Please indicate the address to which you wish your correspondence to be sent (3):                       Residential   Business       Neither
Please indicate which address you wish to appear in the online Directory of Members (3):                Residential   Business       Neither
Please provide your e-mail address. Your e-mail address will be used for outbound e-mails. It must be unique to you and not shared.

E-mail


ACCA is committed to developing sustainable and environmentally-friendly processes and channels of communication. You can actively
support ACCA in this objective by opting to receive selected correspondence and publications in electronic format. To ensure that you receive
only the type of information you require by e-mail, please tick one of the four boxes below:
      No electronic mails (for those who do not wish to receive any information by e-mail)
      One to one e-mails only (for those who would only like to receive correspondence e-mails)
      ACCA campaign e-mails (for those who would like to receive one to one e-mails and promotional e-mails relating to events/courses/
      questionnaires)
      ACCA and third party e-mails (for those who would like to receive one to one e-mails, ACCA campaign e-mails and e-mails from third
      parties with prior approval from ACCA).
Do you wish your e-mail address to be included in the online Directory of Members?                                       Yes              No
Please indicate if you wish to access ACCA’s AGM papers online.                                                          Yes              No
Your details are retained on ACCA’s membership database for administrative and regulatory purposes, in accordance with ACCA’s registration
under data protection legislation. While ACCA never sells its mailing list to third parties, it does undertake strictly controlled mailings on
behalf of selected third parties where the product or service being advertised is likely to be of interest or use to accountants.
If you wish to receive such mailings, please indicate your express consent by ticking the box (3):


2
   EMPLOyMENT CATEGORy

Which best describes your organisation?            National organisation       Presence in 2–10 countries        Multinational organisation



PUBLIC PRACTICE
   If you work in public practice insert a tick in this box. Please also complete the Job category and Number of partners/directors
   by inserting a tick in the relevant boxes.
Nature of firm?
If all of the partners/directors are members of the Association of Chartered Certified Accountants, the firm is Chartered Certified. If all of the
partners/directors are members of one, or more, of the Institutes of Chartered Accountants in England and Wales, Ireland or Scotland, the
firm is Chartered. If all of the partners/directors are members of ACCA and one, or more, of the above-mentioned Institutes, the firm is Mixed
Chartered Certified/Chartered. If all of the partners/directors are members of the Association of Authorised Public Accountants, the firm is
Authorised. Any other combination of partners/directors, including firms with unqualified partners, is Other.
   Chartered Certified             Mixed Chartered Certified/Chartered        Chartered
   Authorised                      Other (specify) ___________________________________
Members in the UK and Ireland working in public practice will automatically be enrolled in the Practitioners’ Network/ACCA Ireland
Practitioners’ Network, as applicable, unless indicated otherwise in the Members’ Network enrolment section on page 4.
Job category
Which one of the categories below best describes your work?
   General practising services
OR specialising in:
   Audits                                    Insolvency                            Taxation
   Management consultancy                    Information technology                Other (specify)____________________________________
Number of partners/directors?
   Sole practitioner        2–3          4–6          7–9             10–99        100+



INDUSTRy, COMMERCE OR PUBLIC SECTOR
   If you work in industry, commerce or public sector insert a tick in this box. Please also complete the Job category and Size of
   organisation by inserting a tick in the relevant boxes.
Business category
Which one of the categories below best describes your employment?
   Retail/consumer                           Energy and utilities               Manufacturing/industry/engineering
   Transport/distribution                    Professional services              IT/communications
   Pharmaceuticals/healthcare                Leisure/tourism/travel             Other (specify) _______________________________________
Members in the UK and Ireland working in the above categories will be enrolled in the Corporate Sector Network unless indicated
otherwise in the Members’ Network enrolment section on page 4.
   Banking                                   Insurance/investment
Members in the UK and Ireland working in the above categories will be enrolled in the Financial Services Network/ACCA Ireland Financial
Services Network, as applicable, unless indicated otherwise in Members’ Network enrolment section on page 4.
   Education              Local government            National government             Not for profit
Members in the UK and Ireland working in the above categories will be enrolled in the Public Sector Network unless indicated otherwise
in Members’ Network enrolment section on page 4.
   Health
Members in the UK and Ireland working in the above category will be enrolled in the Health Service Network unless indicated otherwise
in Members’ Network enrolment section on page 4.
Job category
Which one of the categories below best describes your work?
   Internal auditing                 Data processing/management services               Financial accounting
   General management                Financial management/treasurership                Management accounting
   Company secretarial               Taxation                                          Other (specify)_________________________________
Size of organisation?
   1–10          11–50            51–250           251–2000             2001+



                                                                                                                                                3
NOT EMPLOyED
    If you are not employed please insert a tick in this box.



MEMBERS NETWORK
A member in the UK or Ireland will normally be enrolled with the regional members’ network/district society covering his/her residential
address, which will involve receiving mailings directly from that society.
If you do NOT wish to be enrolled, tick here (3):
A member in the UK or Ireland will normally be enrolled with the employment based members’ network covering his/her
employment category, which will involve receiving mailings directly from that network.
If you do NOT wish to be enrolled, tick here (3):




    ETHNIC MONITORING

In order that ACCA can monitor effectively, please indicate your ethnic origin by crossing one box below only.
Supplying this information is optional. However, please note that by supplying this information, you are giving consent to ACCA to store this
information on either computer or manual files and to use it for statistical purposes on an anonymous and confidential basis.
    Asian – Bangladeshi           Asian – Chinese            Asian – Indian      Asian – Malay           Asian – Pakistani         Asian – other
    Black – African               Black – Caribbean          Black – other       White                   Other




    MEMBERSHIP OF OTHER PROFESSIONAL BODIES

I am a member of the following professional bodies:                           Institute of Chartered Accountants (Ghana)
    Institute of Chartered Accountants in England and Wales                   Institute of Chartered Accountants of Barbados
    Institute of Chartered Accountants of Scotland                            Zambia Institute of Certified Accountants
    Institute of Chartered Accountants in Ireland                             Society of Accountants in Malawi
    Chartered Institute of Management Accountants                             Malaysian Association of Certified Public Accountants
    Chartered Institute of Public Finance & Accountancy                       Malaysian Institute of Accountants
    Chartered Institute of Taxation                                           Hong Kong Institute of Certified Public Accountants
    Institute of Certified Public Accountants in Ireland                      Institute of Internal Auditors
    Institute of Taxation in Ireland                                          Institute of Chartered Secretaries & Administrators
    Insolvency Practitioners’ Association                                     Institute of Management
    Association of Authorised Public Accountants                              Law Society of England and Wales
    Institute of Certified Public Accountants of Cyprus                       Law Society of Scotland
    Institute of Certified Public Accountants of Kenya                        Law Society of Ireland
    Institute of Certified Public Accountants of Singapore                    Law Society of Northern Ireland
    Institute of Chartered Accountants of Nigeria                             Other professional qualifications (please specify)
    Institute of Chartered Accountants of Jamaica
    Institute of Chartered Accountants of Trinidad & Tobago                   ___________________________________________________
    Institute of Chartered Accountants of Guyana




4
  EMPLOyMENT HISTORy

You should:
•	 start	with	your	current,	or	most	recent,	position
•	 include	all periods of employment, not just those which were accountancy, or accountancy related, positions. Please indicate if the
   position is/was full-time, part-time and if the company has now ceased trading
•	 use	the	job	title(s)	used	by	your	employer(s)
•	 include	all	periods	of	full-time	study
•	 give	full	details	of	any	breaks	in	your	employment
•	 continue	on	a	separate	sheet	if	there	is	insufficient	space	in	this	form.

ACCA reserves the right to contact your employer/past employers in order to verify this information.

1 Employer’s name

   Name of supervising principal/workplace mentor/manager

   Qualifications of above (if any)

   Employer’s address

   Tel                                                               Fax

   E-mail

   Your job title                                                    Start date                         Finish date

   Additional comments (eg full-time/part-time/ceased trading)




2 Employer’s name

   Name of supervising principal/workplace mentor/manager

   Qualifications of above (if any)

   Employer’s address

   Tel                                                               Fax

   E-mail

   Your job title                                                    Start date                         Finish date

   Additional comments (eg full-time/part-time/ceased trading)




3 Employer’s name

   Name of supervising principal/workplace mentor/manager

   Qualifications of above (if any)

   Employer’s address

   Tel                                                               Fax

   E-mail

   Your job title                                                    Start date                         Finish date

   Additional comments (eg full-time/part-time/ceased trading)




                                                                                                                                         5
    PRACTICAL EXPERIENCE – STUDENT TRAINING RECORD (STR)

The next three pages must be completed only by applicants who have fully completed their experience under the STR requirement. If you
have transferred your STR elements of competence to performance objectives under the new practical experience requirement, complete
page 9.
To be admitted to full membership, you must demonstrate that you have obtained at least three years of acceptable, supervised, practical
experience and have reached the required standard in at least 16 elements of competence, including:
•	 at	least	12	technical	elements	of	competence	(key	areas	1	–	8),	including	a	minimum	of	six	key	technical	elements	of	competence	which	
   must be taken from at least two key areas (marked with the symbol K ); and
•	 all	four	mandatory	management	elements	of	competence	(marked	with	the	symbol							)	in	key	area	9.
                                                                                     M

you should only cross boxes below where your current employer or previous employers will be prepared to confirm as accurate your
achievement of the competences in question.
Name(s) of the company(ies)/organisation(s)/firm(s) in which the experience was obtained:

                                                                                                                                                                                 Mark (X)
                                                                                                                                                                                 in the
                                                                                                                                                                                 appropriate
                                                                                                                                                                                 boxes




Please note that failure to confirm the required elements will delay your application for full membership

                                                                                Element 1    Appraise information for the preparation of financial and other statements
                                                 Unit A                                                                                                                               K
                                                                                             and accounts
                                                 Prepare financial and other
                                                 statements and accounts for
                                                 external purposes              Element 2    Prepare and present financial and other statements and accounts                          K



                                                 Unit B                         Element 3    Appraise financial information for the preparation of management information             K
             Financial Information




                                                 Prepare financial
    KEy AREA 1




                                                 information for management     Element 4    Prepare and present financial information for management purposes                        K



                                                 Unit C                         Element 5    Advise on relevant regulatory obligations                                                K
                                                 Advise and support clients/
                                                 management in meeting
                                                 their regulatory obligations   Element 6    Provide support in meeting regulatory obligations


                                                                                Element 7    Identify potential changes to an organisation’s accounting systems                       K
                                                 Unit D
                                                 Assist in the development
                                                                                Element 8    Assist in the introduction of new/changes to accounting systems
                                                 and implementation of
                                                 accounting systems
                                                                                Element 9    Assist in the evaluation of changes to accounting systems



                                                                                Element 10   Assist in identifying financial objectives and performance measures                      K
                                                 Unit A
                                                 Assist in the planning and     Element 11   Assist in the introduction of systems and practices to plan and monitor financial
                                                 monitoring of business                      performances
             Business Analysis and Measurement




                                                 performance
                                                                                Element 12   Assist in monitoring the achievement of financial performance and objectives             K
    KEy AREA 2




                                                                                Element 13   Identify the cost of products and services

                                                 Unit B                         Element 14   Identify the potential profitablity of products and services
                                                 Identify and analyse the
                                                 costs associated with
                                                                                Element 15   Calculate the actual costs of products and services
                                                 products and services
                                                                                Element 16   Make recommendations to reduce costs and enhance value

                                                                                Element 17   Prepare spending proposals and profiles                                                  K

                                                 Unit C
                                                 Control expenditure and        Element 18   Agree budgets for activities                                                             K
                                                 monitor budgets
                                                                                Element 19   Monitor and report on budgets                                                            K




6
                                                                                                                                                            Mark (X)


                                                                 Element 20   Compute the tax payable by the client/organisation                            K
   KEy AREA 3
                                 Unit A
                                 Compute tax payable
                                                                 Element 21   Negotiate with the tax authorities
              Taxation




                                 Unit B                          Element 22   Advise on tax liabilities and payments
                                 Develop plans for tax
                                 liabilities                     Element 23   Assist clients/management with tax planning                                   K




                                                                 Element 24   Determine the level of audit risk                                             K

                                 Unit A
                                 Prepare for and control the     Element 25   Evaluate the control risk within an organisation’s accounting systems         K
                                 statutory audit process
   KEy AREA 4




                                                                 Element 26   Co-ordinate the delivery of statutory audit evidence
              Statutory Audit




                                                                 Element 27   Evaluate evidence collected for a statutory audit
                                 Unit B
                                 Collect evidence and            Element 28   Make judgements about the truth and fairness of an organisation’s financial
                                                                                                                                                            K
                                 evaluate risk for a statutory                statements
                                 audit
                                                                 Element 29   Review the performance of a statutory audit

                                 Unit C                          Element 30   Advise on the findings and iplications of the audit
                                 Report on the findings of
                                 the audit                       Element 31   Prepare a formal audit report                                                 K




                                 Unit A                          Element 32   Determine the scope, purpose and objectives of an internal review             K

                                 Prepare for and control and
         Internal Review and
KEy AREA 5




                                 internal review                 Element 33   Co-ordinate the delivery of evidence for an internal review
             Consultancy




                                                                 Element 34   Obtain evidence for analysis against the objectives of an internal review
                                 Unit B
                                 Deliver the objectives of an    Element 35   Make judgements against the objectives of an internal review                  K
                                 internal review
                                                                 Element 36   Report on the findings and outcomes of an internal review                     K




                                 Unit A                          Element 37   Assess the organisation’s working capital requirements
                                 Monitor and maintain the
                                 organisation’s working
                                 capital requirements            Element 38   Co-ordinate the provision of working capital
              Asset Management
   KEy AREA 6




                                                                 Element 39   Contribute to the specification of credit and debit policies and mechanisms
                                 Unit B
                                 Contribute to controlling       Element 40   Monitor and maintain credit control mechanisms
                                 credit and monitoring debt
                                                                 Element 41   Monitor and control the level of outstanding debt

                                                                 Element 42   Determine the risks and benefits associated with business/investment
                                                                                                                                                            K
                                 Unit C                                       opportunities
                                 Evaluate potential business/
                                 investment opportunities        Element 43   Identify ways to optimise the use of assets                                   K




                                                                                                                                                                  7
                                                                                                                                                                        Mark (X)


                                                                             Element 44   Assist in folmulating business strategy                                       K
                                               Unit A
                                               Contribute to formulating
                                                                             Element 45   Assist in the setting of business targets and objectives
                                               business strategy and
                                               objectives
             Business Growth and development




                                                                             Element 46   Develop plans to achieve business targets and objectives
    KEy AREA 7




                                                                             Element 47   Identify and evaluate new ideas for products and services

                                               Unit B
                                               Contribute to developing      Element 48   Contribute to the identification of changes to products and services
                                               products and services
                                                                             Element 49   Define and implement plans for the introduction of changes to products and
                                                                                          services

                                                                             Element 50   Specify customer service standards and policies
                                               Unit C
                                               Monitor and maintain
                                                                             Element 51   Implement and monitor customer service standards and policies
                                               the quality of service to
                                               customers
                                                                             Element 52   Promote continuous quality improvement in products, services and processes    K




                                               Unit A                        Element 53   Identify information system requirements                                      K
                                               Advise on information
                                               systems to meet
             Manage Information Systems




                                               requirements                  Element 54   Assist in establishing structures to deliver information systems
    KEy AREA 8




                                               Unit B                        Element 55   Contribute to the design of information systems
                                               Specify information
                                               systems to meet identified
                                               requirements                  Element 56   Manage the system specification


                                               Unit C                        Element 57   Implement information systems which meet requirements                         K

                                               Install information systems
                                               to meet requirements          Element 58   Review and evaluate implemented information systems



                                               Unit A                        Element 59   Develop and maintain effective and ethical business relationships             M
                                               Develop and maintain
                                               effective and ethical
                                               relationships                 Element 60   Develop and maintain effective and ethical relationships with colleagues      M


                                                                             Element 61   Identify personnel requirements and role specifications
                                               Unit B
    KEy AREA 9




                                                                             Element 62   Recruit and select teams and individuals
                                               Recruit and develop people
             Manage People




                                                                             Element 63   Develop teams and individuals

                                               Unit C                        Element 64   Maintain an awareness and understanding of changes affecting the profession   M
                                               Prioritise own ongoing
                                               personal and professional     Element 65   Demonstrate a commitment to own ongoing personal and professional
                                               development                                                                                                              M
                                                                                          development

                                                                             Element 66   Identify and agree objectives and methods to deliver required outcomes
                                               Unit D
                                               Lead others to achieve        Element 67   Delegate activities to teams and individuals
                                               objectives
                                                                             Element 68   Monitor the work of others




8
This page must be completed by applicants who have completed their experience under the new PER, including those who have
transferred STR elements of competence to PER performance objectives.

In order to meet ACCA’s practical experience requirement, you must demonstrate effectiveness and achievement in the workplace by meeting
ACCA’s performance objectives, overseen and agreed by a workplace mentor.

Performance objectives are divided into nine key areas of knowledge which are closely linked to the exam syllabus. You will be required to
achieve 13 performance objectives in total – all nine from Essentials and any four from Options.

You will have demonstrated that you have achieved a particular performance objective by responding to a set of challenge questions. Please
note that you will need to retain hard copies of your answers to related challenge questions and the sign-off by your workplace mentor, as
ACCA may require to view these for PER audit purposes. You should only cross the performance objectives below that have been reviewed
and signed off by your workplace mentor. Alternatively, you may have achieved some of your performance objectives through transferring the
STR elements of competence you have previously achieved to performance objectives.

Or you may wish to claim exemption from completing this page on the basis that (please indicate):

  You work for a gold or platinum ACCA Approved Employer – trainee development (provide your employer’s name below) and your
  employer has agreed to you claiming the exemption



  You are resident in Hong Kong and following the Hong Kong Institute of Certified Public Accountant’s PER route.


                                                                                                                                     Mark (X)


                                                1   Demonstrate the application of professional ethics, values and judgement
                  Professionalism, ethics and
                                                2   Contribute to the effective governance of an organisation
                  governance
                                                3   Raise awareness of non-financial risk
     ESSENTIALS




                                                4   Manage self

                  Personal effectiveness        5   Communicate effectively

                                                6   Use information and communications technology

                                                7   manage on-going activities in your area of responsibility

                  Business management           8   Improve departmental performance

                                                9   Manage an assignment



                  Financial accounting and      10 Prepare financial statements for external purposes
                  reporting                     11 Interpret financial transactions and financial statements

                                                12 Prepare financial information for management
                  Performance measurement
                  and management                13 Contribute to budget planning and production
                  accounting
     OPTIONS




                                                14 Monitor and control budgets

                  Finance and financial         15 Evaluate potential business/investment opportunities and the required finance
                  management                    16 Manage cash using active cash management and treasury systems

                                                17 Prepare for and collect evidence for audit
                  Audit and assurance
                                                18 Evaluate and report on audit

                                                19 Evaluate and compute taxes payable
                  Taxation
                                                20 Assist with tax planning




  Please indicate by marking an ‘X’ if you have undertaken statutory audit work in the last 12 months

  Please indicate by marking an ‘X’ if the workplace mentor who has signed off your performance objectives is a qualified accountant
  recognised by law in your country

  Please indicate by marking with an ‘X’ if the achievement of your performance objectives has been reviewed and countersigned by a
  training supervisor who is a qualified accountant recognised by law in your country.


                                                                                                                                             9
      REFERENCE REQUIREMENTS

We need to receive an up-to-date reference(s), preferably from your current or most recent employer, in support of your application for
membership. You will need to provide just one reference in circumstances where:
•		your	referee	can	confirm	that	you	have	obtained	three	years	of	relevant	practical	experience	under	his/her	supervision;	and
•	 he/she has been your supervisor at your current or most recent employer.

If you cannot provide the name of a single referee who meets the above criteria, you will need to provide the names of two (or more)
referees:
•	 who	between	them	can	confirm	that	you	have	obtained	three	years	of	relevant	practical	experience	under	their	supervision;	and
•	 at	least	one	of	whom	has	been	your	supervisor	at	your	most	recent	employer.

It is preferable that each referee should be an ACCA member, or a member of another professional accountancy body, who will have an
understanding of the practical experience requirements for becoming a member of ACCA. However, this is not compulsory. Furthermore,
in circumstances where you are the most senior member of accountancy staff in your organisation, it is acceptable for your organisation’s
auditor to provide you with a reference.

If you wish to use up to one year of your pre-membership experience towards your eligibility for an ACCA practising certificate or ACCA
practising certificate and audit qualification the experience should be obtained in an ACCA approved employer – practising certificate
development and your reference(s) must be from the training principal or partner. For an ACCA practising certificate and audit qualification
the reference(s) must be from an audit principal. ACCA reserves the right to request additional information as deemed necessary.

You are advised to send to your referee(s) one of the reference forms attached to the end of this application form. Where possible, to avoid delays
in processing your application, these completed references should be submitted with this application form. Additional copies of the reference
form can be downloaded from the ACCA website.

First referee
Name

Title (3)       Mr      Mrs        Miss        Ms       Dr        Other (please specify)

Address



Tel                                                                      Fax

E-mail

Job title/occupation

This referee can confirm that I have obtained three years of relevant practical experience.                                         Yes         No

(If you have ticked ‘No’, please provide the name and contact details of a further referee(s). Remember that, between them, your referees
must be able to confirm that you have obtained three years of relevant practical experience.)

I have contacted this referee to ask him/her to send a reference to ACCA.                                                           Yes         No

Second referee (if required)
Name

Title (3)       Mr      Mrs        Miss        Ms       Dr        Other (please specify)

Address



Tel                                                                      Fax

E-mail

Job title/occupation

I have contacted this referee to ask him/her to send a reference to ACCA.                                                           Yes         No


Please continue on a separate sheet if you need to provide details of further referee(s).


10
   DECLARATION

THIS PAGE MUST BE COMPLETED By ALL APPLICANTS

I confirm that the information contained in this form is true, accurate and complete to the best of my knowledge and belief.
I understand that any false or misleading statement in this form could lead to disciplinary action being taken against me and/or may
invalidate any decision reached on this application. I have read bye-law 8, liability to disciplinary action, at the back of this form, and there
is nothing I should bring to ACCA’s attention at the present time. I understand that the UK Rehabilitation of Offenders Act 1974 does not
apply to the accountancy profession, and that I am, therefore, required to disclose spent convictions.

If this is an application for full membership, I undertake, that if admitted as a member I will, so long as I remain a member of ACCA, abide
by the bye-laws and all regulations made thereunder. I further undertake that I will use the designation ‘Chartered Certified Accountant’ and
the designatory letters ‘ACCA’ (or ‘FCCA’ when I become a fellow) only while I remain a member of ACCA.

I acknowledge my duty to maintain the quality of my knowledge and will undertake adequate continuing professional development as
directed by Council and specified in the Chartered Certified Accountants’ Membership Regulations. I understand that I will be invoiced for
the admission fee (£181 in 2009) on the acceptance of my application.

If this is an application for an affiliate certificate, I undertake that I will notify ACCA as soon as I have obtained three years of practical
experience and will apply for full membership. I further undertake that I will not, in any context, claim or otherwise imply that I am a
member of ACCA and will not use ACCA’s designation or designatory letters.


Signature                                                                                                         Date



CHECKLIST
Applicants applying for full membership
Please ensure you have:

   Completed pages 2 – 5 and 10

   Completed pages 6 – 8 (detailing 12 technical and all four mandatory management elements) or
   Completed page 9 (detailing all nine from Essentials and any four from Options) performance objectives.

   Submitted any further supporting documentation ie confirmation of employment letters/testimonials

   Requested/attached your up-to-date reference(s) confirming your three years’ practical experience

   Signed the declaration above.

Applicants applying for affiliate status
Please ensure you have:

   Indicated a date when you expect to have obtained three years of relevant practical experience – page 1

   Completed the personal details section – pages 2 – 4

   Completed the employment history sections – page 5

   Signed the declaration above.




                                                                                                                                                  11
     ByE-LAW 8. LIABILITy TO DISCIPLINARy ACTION

8     a   A member, relevant firm or registered student shall, subject to bye-law 11, be liable to disciplinary action if:

          i     he or it, whether in the course of carrying out his or its professional duties or otherwise, has been guilty of misconduct;

          ii    in connection with his or its professional duties, he or it has performed his or its work, or conducted himself or itself, or
                conducted his or its practice, erroneously, inadequately, inefficiently or incompetently;

          iii   he or it has committed any breach of these bye-laws or of any regulations made under them in respect of which he or it is
                bound;

          iv    in the case of a relevant firm, any person has in the course of the business of that firm committed any breach of these bye-laws
                or of any regulations made under them in respect of which that person is bound;

          v     he is a specified person in relation to a relevant firm against which a disciplinary order has been made and which has become
                effective or which has been disciplined by another professional body or pursuant to some other disciplinary process;

          vi    he or it has been disciplined by another professional body or pursuant to some other disciplinary process;

          vii he or it has made an assignment for the benefit of creditors, or has made an arrangement for the payment of a composition to
              creditors, or has had an interim order made by the court in respect of him, or is a specified person in relation to a relevant firm
              which has made such an assignment or composition or been wound up as an unregistered company, or entered into a voluntary
              arrangement, administration or liquidation, in each case where applicable under the Insolvency Act 1986, or other similar or
              analogous event has occurred in relation to him or it under applicable legislation; or

          viii he or it has failed to satisfy a judgment debt without reasonable excuse for a period of two months (and the fact that he or it
               did not have sufficient funds to discharge the debt shall not be a reasonable excuse for this purpose) whether or not the debt
               remains outstanding at the time of the bringing of the disciplinary proceedings hereunder.

      b   Each of the paragraphs in bye-law 8(a) shall be without prejudice to the generality of any of the other paragraphs therein.

      c   For the purposes of bye-law 8(a), misconduct includes (but is not confined to) any act or omission which brings, or is likely to bring,
          discredit to the individual or relevant firm or to the Association or to the accountancy profession.

      d   For the purposes of bye-law 8(a), in considering the conduct alleged (which may consist of one or more acts or omissions), regard
          may be had to the following:

          i     whether an act or omission, which of itself may not amount to misconduct, has taken place on more than one occasion, such
                that together the acts or omissions may amount to misconduct;

          ii    whether the acts or omissions have amounted to or involved dishonesty on the part of the individual or relevant firm in
                question;

          iii   the nature, extent or degree of a breach of any code of practice, ethical or technical, adopted by Council, and to any regulation
                affecting members, relevant firms or registered students laid down or approved by Council.

      e   The following shall be conclusive proof of misconduct:

          i     the fact that a member, relevant firm or registered student has pleaded guilty to, or been found guilty of, any offence
                discreditable to him or, as the case may be, it, or derogatory to the Association or the accountancy profession, before a court of
                competent jurisdiction in the United Kingdom or before a court of competent jurisdiction any other country where such court’s
                judgments are in the opinion of Council (or relevant committee of Council) relevant;

          ii    the fact that a member, relevant firm or registered student has been found to have acted fraudulently or dishonestly in any civil
                proceedings before any court of competent jurisdiction in the United Kingdom or before a court of competent jurisdiction in any
                other country where such court’s judgments are enforceable in the United Kingdom.




12
PRIvATE AND CONFIDENTIAL




To:




Date:

Reference required for:

ACCA registration number:


Dear Referee

REFERENCE

The above named has applied for membership of ACCA and has nominated you
as a referee.

In addition to completing our examinations, applicants must satisfy ACCA that
their practical experience has been of a scope and character appropriate to a
professional qualification. We should be grateful, therefore, if you would let us
have your comments in this regard.

You may either complete and return the form on the reverse of this letter or
send a separate letter, taking into account the points covered in the form, as
you prefer.

The applicant’s application for membership cannot be approved until this
reference is received, so we would be grateful if you would reply as soon as
possible. We should like to thank you in advance for your assistance.

Please do not hesitate to contact ACCA on +44 (0)141 582 2000 if you have
any questions regarding this matter.




                                          2 CENTRAL QUAY   T +44 (0)141 582 2000   www.accaglobal.com
                                      89 HYDEPARK STREET   F +44 (0)141 582 2222
                                     GLASGOW G3 8BW UK
PLEASE COMPLETE IN BLOCK CAPITALS


Reference for:

ACCA registration number (please refer to the covering letter for this number):

1 Dates of employment:             Start date:                                      Finish date:

2 Applicant’s job title(s) while employed by your company/organisation/firm:




3 Did the applicant normally report to you?                            Yes            No

   If no, please confirm your relationship to the applicant:

4 Please give details of the accountancy duties and other responsibilities undertaken by the applicant:




5 Please give your assessment of the applicant’s skills and attributes by ticking the relevant boxes below:

                                                                                                                 Excellent        Good   Satisfactory   Poor
   Skill and competence in accountancy
   Extent to which a professional approach to work was developed
   Ability to communicate
   Ability to show initiative
   Ability to exercise judgement

6 What would you say were the applicant’s main strengths




7 In which areas would you say the applicant needs to develop




8 Please use the space below to provide any additional comments or information that you feel would be helpful:




   Your name:

   Signature:

   (It is important that this reference letter should be signed in your name and not in the name of the company/organisation/firm.)


   Your job title:

   Company/organisation/firm name where you supervised the applicant:

   Professional qualification(s), if applicable:


Once completed, please return to: ACCA 2 Central Quay 89 Hydepark Street Glasgow G3 8BW United Kingdom
PRIvATE AND CONFIDENTIAL




To:




Date:

Reference required for:

ACCA registration number:


Dear Referee

REFERENCE

The above named has applied for membership of ACCA and has nominated you
as a referee.

In addition to completing our examinations, applicants must satisfy ACCA that
their practical experience has been of a scope and character appropriate to a
professional qualification. We should be grateful, therefore, if you would let us
have your comments in this regard.

You may either complete and return the form on the reverse of this letter or
send a separate letter, taking into account the points covered in the form, as
you prefer.

The applicant’s application for membership cannot be approved until this
reference is received, so we would be grateful if you would reply as soon as
possible. We should like to thank you in advance for your assistance.

Please do not hesitate to contact ACCA on +44 (0)141 582 2000 if you have
any questions regarding this matter.




                                          2 CENTRAL QUAY   T +44 (0)141 582 2000   www.accaglobal.com
                                      89 HYDEPARK STREET   F +44 (0)141 582 2222
                                     GLASGOW G3 8BW UK
PLEASE COMPLETE IN BLOCK CAPITALS


Reference for:

ACCA registration number (please refer to the covering letter for this number):

1 Dates of employment:             Start date:                                      Finish date:

2 Applicant’s job title(s) while employed by your company/organisation/firm:




3 Did the applicant normally report to you?                            Yes            No

   If no, please confirm your relationship to the applicant:

4 Please give details of the accountancy duties and other responsibilities undertaken by the applicant:




5 Please give your assessment of the applicant’s skills and attributes by ticking the relevant boxes below:

                                                                                                                 Excellent        Good   Satisfactory   Poor
   Skill and competence in accountancy
   Extent to which a professional approach to work was developed
   Ability to communicate
   Ability to show initiative
   Ability to exercise judgement

6 What would you say were the applicant’s main strengths




7 In which areas would you say the applicant needs to develop




8 Please use the space below to provide any additional comments or information that you feel would be helpful:




   Your name:

   Signature:

   (It is important that this reference letter should be signed in your name and not in the name of the company/organisation/firm.)


   Your job title:

   Company/organisation/firm name where you supervised the applicant:

   Professional qualification(s), if applicable:


Once completed, please return to: ACCA 2 Central Quay 89 Hydepark Street Glasgow G3 8BW United Kingdom

				
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